Provider Demographics
NPI:1932873262
Name:BUTLER, REILLY LYN (PA-C)
Entity Type:Individual
Prefix:
First Name:REILLY
Middle Name:LYN
Last Name:BUTLER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1325 E SHERMAN BLVD
Mailing Address - Street 2:
Mailing Address - City:NORTON SHORES
Mailing Address - State:MI
Mailing Address - Zip Code:49444-1813
Mailing Address - Country:US
Mailing Address - Phone:231-737-8446
Mailing Address - Fax:231-737-0510
Practice Address - Street 1:1325 E SHERMAN BLVD
Practice Address - Street 2:
Practice Address - City:NORTON SHORES
Practice Address - State:MI
Practice Address - Zip Code:49444-1813
Practice Address - Country:US
Practice Address - Phone:231-737-8446
Practice Address - Fax:231-737-0510
Is Sole Proprietor?:No
Enumeration Date:2021-08-02
Last Update Date:2021-08-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI5601010476363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant